Living with mental health conditions like schizophrenia or depression is challenging. However, many find that dealing with the stigma and negative perceptions from others, and sometimes from themselves, can be even more difficult.
Charlene Sunkel, founder of the Global Mental Health Peer Network and co-chair of the Lancet Commission on Ending Stigma and Discrimination in Mental Health, shares her experience. “I live with schizophrenia. It is amazing how people react the moment they hear the word – they immediately take a step back,” she says. “They are afraid because of this false perception that we are dangerous, unable to think, or work – that we are basically useless.”
Stigma involves not just negative attitudes but also discriminatory behaviors. This is why many use the term “stigma and discrimination” together.
Professor Sir Graham Thornicroft of King’s College London and co-chair of the Lancet Commission, explains a concept called “diagnostic overshadowing.” He describes a scenario where a person with depression develops severe stomach pain and visits an emergency department. The doctor, seeing the patient’s history of depression, might dismiss the pain as a mental issue, potentially missing a life-threatening condition like an impending burst appendix. This example, while dramatic, illustrates the severe consequences of stigma.
The Barrier to Thriving
Both Charlene and Graham approach stigma reduction from different perspectives: Charlene as a care user and Graham as a care provider.
Graham, a psychiatrist and researcher, recognized that stigma sets psychiatry apart from other medical fields. A diagnosis can lead to enduring negative attitudes and misinformation, such as the belief that people with depression cannot recover. This prejudice can lead to discrimination at both the personal and structural levels, including laws and policies. Stigma is also a reason why mental health services receive less funding and prestige in many countries.
Self-stigma can lead to poor self-esteem and a “why-try syndrome,” where individuals avoid important activities like applying to university, believing they will fail. Charlene’s experience with schizophrenia highlighted this barrier. “I was told I’d never be able to work,” she recalls. “It was only after talking with peers that I realized stigma is probably the biggest barrier to gaining our lives back and thriving.”
Evidence and Solutions
In 2022, Graham and Charlene, along with 42 other researchers and individuals with lived experience, produced the Lancet Commission on Ending Stigma and Discrimination in Mental Health. This comprehensive review of 216 systematic studies, supplemented with personal stories, summarizes the best evidence on reducing stigma and discrimination.
Stigma is often addressed through mental health literacy, aiming to correct misinformation and reduce prejudice. However, Graham notes that simply correcting knowledge doesn’t significantly reduce prejudice.
According to the Lancet Commission, the most effective way to reduce stigma is through social contact – interactions between people with and without mental health conditions. These interactions, whether in-person or virtual, help change attitudes and improve behaviors by sharing experiences of living with mental health conditions.
Social contact encourages empathy and recognizes the agency of individuals with mental health conditions. Experts by experience, those who live with mental health conditions, often lead these initiatives, making them more effective. Charlene emphasizes, “We have so much value to add because of our experiences. It’s not something you can study. We bring practical solutions.”
Moving Forward
The Lancet Commission offers eight recommendations for various stakeholders, including the World Health Organization (WHO), to reduce stigma and discrimination. Charlene and her organization, the Global Mental Health Peer Network, focus on empowering people with mental health conditions through funded programs and training opportunities. “Inclusion in employment, education, and communities is key,” says Charlene. “By including people, others can see they are human beings deserving of dignity and human rights.”
Graham and his team at King’s College London have partnered with WHO/Europe and the Global Mental Health Peer Network to develop the WHO MOSAIC toolkit. This toolkit provides practical guidance for setting up anti-stigma initiatives based on social contact, co-leadership by individuals with lived experience, and meaningful collaboration. The toolkit, currently undergoing expert consultation, was recently presented at a workshop in Brussels, Belgium, in May 2024.
